Background and Aim: Imaging techniques are pivotal in the assessment of lung structure and function, particularly in diagnosing respiratory ailments. Among these, ultrasound strain elastography (SE) presents a promising avenue for evaluating peripherally located lung parenchymal lesions and distinguishing between benign and malignant pathologies. This study aims to explore the applicability and reliability of ultrasound elastography (USE) in tissue differentiation and establishing a strain ratio (SR) cutoff value via (SE) for accurate classification.